Etoposide (Intravenous)

Etoposide injection (also known as VP-16) is used along with other cancer medicines to treat testicular cancer and small cell lung cancer. It may also be used for some other types of cancer in both men and women.

Etoposide is part of a group of medicines called antineoplastic agents. The exact way etoposide works against cancer is not known. However, it appears to disrupt the growth of cancer cells, which are eventually destroyed. Etoposide can also affect the growth of normal body cells, leading to other effects. Some of these effects can be serious and need to be reported to your doctor. Other effects, such as hair loss, may not be serious but could be concerning. Some effects might not appear until months or years after the treatment.

Before starting treatment with etoposide, you and your doctor should discuss the benefits and risks of this medicine.

This medicine should only be given by or under the supervision of your doctor.

It is very important for your doctor to check your progress at regular visits to ensure that this medicine is working correctly. Blood tests may be needed to check for side effects.

Using this medicine while you are pregnant can harm your unborn baby. Use an effective form of birth control to prevent pregnancy during treatment and for at least 6 months after your last dose. If you think you might be pregnant while using this medicine, tell your doctor right away.

Etoposide may also cause birth defects if the father is using it when his partner becomes pregnant. Men using this medicine should use condoms as a form of birth control during treatment and for at least 4 months after the last dose of etoposide. A man planning to have a child should stop using this medicine and consult his doctor immediately.

Etoposide can temporarily lower the number of white blood cells in your blood, which increases the risk of getting an infection. It can also lower the number of platelets, which are needed for proper blood clotting. If this happens, there are certain precautions you can take, especially when your blood count is low, to reduce the risk of infection or bleeding:

• If possible, avoid people with infections. Contact your doctor immediately if you think you are getting an infection or if you have a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination.
• Contact your doctor immediately if you notice any unusual bleeding or bruising, black or tarry stools, blood in your urine or stools, or pinpoint red spots on your skin.
• Be careful when using a regular toothbrush, dental floss, or toothpick. Your doctor, dentist, or nurse may suggest other ways to clean your teeth and gums. Check with your doctor before having any dental work done.
• Do not touch your eyes or the inside of your nose unless you have just washed your hands and have not touched anything else in the meantime.
• Be cautious when using sharp objects such as safety razors or nail clippers to avoid cutting yourself.
• Avoid contact sports or situations where bruising or injury could happen.

This medicine may cause serious allergic reactions, including anaphylaxis. Anaphylaxis can be life-threatening and requires immediate medical attention. Tell your doctor or nurse right away if you experience chills, fever, lightheadedness, dizziness, or fainting, fast or pounding heartbeat, swelling of the face, tongue, and throat, or trouble breathing after receiving the medicine.

Injection site reactions may occur while you are receiving this medicine. Inform your doctor right away if you notice swelling, pain, or redness at the injection site.

This medicine may rarely cause leukemia (cancer of the blood or bone marrow). Discuss any concerns you have about this with your doctor.

Talk with your doctor before getting flu shots or other vaccines while receiving this medicine, as there are certain vaccines you should not receive.

Do not take other medicines unless you have discussed them with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

In deciding to use a medicine, you and your doctor need to consider the risks of taking the medicine against the benefits it may provide. Here are important points to think about for this medicine:

Allergies

Inform your doctor if you have had any unusual or allergic reactions to this medicine or any other medicines. Also let your healthcare professional know about any other allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, carefully read the label or package ingredients.

Pediatric

Studies have not been done to determine how etoposide injection affects children. Safety and effectiveness have not been confirmed.

Geriatric

Studies so far have not shown any specific problems in older adults that would limit the use of etoposide injection. However, older patients may be more likely to experience unwanted side effects (like infection, nausea and vomiting, hair loss) and may have age-related kidney, liver, or heart issues, which could require caution when giving etoposide injection to elderly patients.

Breast Feeding

There are not enough studies in women to determine the risk to infants when using this medicine while breastfeeding. Consider the potential benefits and risks before taking this medicine while breastfeeding.

Interactions with Medicines

Some medicines should not be used together at all, while in other cases, two different medicines may be used together even if there might be an interaction. If you are receiving this medicine, it is very important for your healthcare professional to know if you are taking any of the medicines listed below. The following interactions have been chosen based on their potential importance and are not all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or adjust some of the other medicines you take.

• Measles Virus Vaccine, Live
• Mumps Virus Vaccine, Live
• Rotavirus Vaccine, Live
• Rubella Virus Vaccine, Live
• Varicella Virus Vaccine, Live
• Zoster Vaccine, Live

Using this medicine with any of the following medicines is usually not recommended, but may be necessary in some situations. If both medicines are prescribed together, your doctor may adjust the dose or the frequency of one or both medicines.

• Adenovirus Vaccine
• Aprepitant
• Bacillus of Calmette and Guerin Vaccine, Live
• Cholera Vaccine, Live
• Cyclosporine
• Dengue Tetravalent Vaccine, Live
• Echinacea
• Fosaprepitant
• Glucosamine
• Influenza Virus Vaccine, Live
• Poliovirus Vaccine, Live
• Smallpox Vaccine
• St John's Wort
• Typhoid Vaccine, Live
• Valspodar
• Warfarin
• Yellow Fever Vaccine

Using this medicine with any of the following medicines may increase the risk of certain side effects, but using both medicines may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Rolapitant

Interactions with Food/Tobacco/Alcohol

Some medicines should not be used around the time of eating food or certain types of food because interactions may occur. Using alcohol or tobacco with certain medicines may also lead to interactions. The following interactions have been chosen based on their potential importance and are not all-inclusive.

Using this medicine with any of the following may increase the risk of certain side effects, but may be necessary in some cases. If used together, your doctor may adjust the dose or frequency of this medicine, or provide special instructions regarding food, alcohol, or tobacco.

• Grapefruit Juice

Other Medical Problems

Having other medical problems may impact the use of this medicine. Be sure to inform your doctor if you have any other medical issues, especially:

• Low serum albumin (protein in the blood)—May lead to increased side effects.

• Infection—May reduce your body's ability to fight infection.

• Kidney disease—Use with caution. The effects of etoposide may be greater due to slower removal from the body.

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

More common

• Black, tarry stools
• bleeding gums
• blood in the urine or stools
• chest pain
• chills
• cough
• fever
• painful or difficult urination
• pale skin
• pinpoint red spots on the skin
• sore throat
• sores, ulcers, or white spots on the lips or in the mouth
• swollen glands
• troubled breathing with exertion
• unusual bleeding or bruising
• unusual tiredness or weakness

Less common

• Blurred vision
• confusion
• cough or hoarseness, accompanied by fever or chills
• difficulty with swallowing
• dizziness
• dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
• face is warm or hot to touch
• fast heartbeat
• headache
• hives, itching, or skin rash
• lower back or side pain, accompanied by fever or chills
• nervousness
• numbness or tingling in the fingers or toes
• pain or redness at the site of injection
• pale skin at the site of injection
• pounding in the ears
• puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
• redness to face
• slow or fast heartbeat
• sweating
• tightness in the chest

Rare

• Back pain
• difficulty with walking
• loss of consciousness
• swelling of the face or tongue
• tightness in the throat

Incidence not known

• Abdominal or stomach pain, severe
• blindness
• blistering, peeling, or loosening of the skin
• blue-yellow color blindness
• dark urine
• decreased vision
• eye pain
• joint or muscle pain
• loss of appetite
• nausea or vomiting
• red, irritated eyes
• red skin lesions, often with a purple center
• seizures
• yellow eyes or skin

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

• Bad, unusual, or unpleasant (after) taste
• change in taste
• constipation
• cracked lips
• hair loss or thinning of the hair
• lack or loss of strength
• swelling or inflammation of the mouth
• weight loss

This medicine often causes a temporary loss of hair. After treatment with etoposide has ended, normal hair growth should return.

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

In the U.S.

• Etopophos
• Vepesid

In Canada

• Dom-Etoposide
• Eposin
• Etoposide
• Pms-Etoposide

Available Dosage Forms:

• Solution
• Powder for Solution

Therapeutic Class: Antineoplastic Agent

Pharmacologic Class: Mitotic Inhibitor

A nurse or other trained health professional will give you this medicine in a hospital or cancer treatment center. This medicine is given through a needle placed in one of your veins. The medicine must be injected slowly, so your IV tube will need to stay in place for 30 to 60 minutes.

Etoposide is sometimes given together with certain other medicines. If you are using a combination of medicines, make sure that you take each one at the proper time and do not mix them. If you are taking some of these medicines by mouth, ask your doctor to help you plan a way to remember to take your medicines at the right times.

Etoposide often causes nausea, vomiting, and loss of appetite, which may be severe. However, it is very important that you continue to receive the medicine, even if you begin to feel ill. Ask your doctor for ways to lessen these effects.

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